Difference in Blood Pressure Measurements in Pregnant Women when using the Gold Standard Method versus Clinical Measurements

Abstract

BackgroundThe World Health Organization lists hypertensive disorders in pregnancy as one of the leading causes of maternal death. It is also known that each year more than 10 million women worldwide suffer from preeclampsia, one of the hypertensive disorders in pregnancy. The accuracy of blood pressure measurement is crucial to making the correct diagnosis and treatment of hypertensive disorders of pregnancy. Taking a BPM is one of the most basic clinical assessments that is done by members of the healthcare team. However, it is often one of the most inaccurately performed assessments. Accurate measurement is critical for proper diagnosis, assess risk, and correct treatment. Inaccurate assessments can cause delay in diagnosis of a hypertensive disorder and increase risks to the mother and child. Conversely, falsely elevated measurements can lead to unnecessary treatments that may be harmful. The American College of Cardiology/American Heart Association recommended guidelines for performing Blood Pressure Measurements that include not smoking, exercising, or drinking caffeinated beverages for 30 minutes prior to measurement. Measurements are taken after 5‐minutes rest in a seated position with arms at the level of the heart without talking. Two measurements, one minute apart, should be taken, preferably with a stethoscope and manual blood pressure cuff, with the average of the values recorded as the blood pressure measurement. Our study aimed to fill a critical gap in knowledge of how blood pressure measurement using the ACC/AHA gold standard guideline compared to routinely taken clinical blood pressures of pregnant women.MethodsWe performed blood pressure measurements on 44 pregnant women following ACC/AHA guidelines. These results were compared to the closest clinical blood pressure measurement that we extracted from the medical record. Duplicate measurements were averaged and Student's t‐test was used to compare the measurement types. P<0.05 was considered significant.ResultsOur results demonstrated a significant statistical difference between blood pressure measurements taken using the AHA/ACC guidelines (N=44, systolic= 108.14 + 11.75 mmHg, diastolic = 66.93 + 8.81 mmHg,) compared to measurements recorded at clinic appointments (systolic = 116.29 + 9.47 mmHg (P<0.001), diastolic = 71.11 + 9.47 mmHg, P=0.004). The average maternal age was 32.2 +/‐ 4.1 years. The average gestational age of participants was 25.8 +/‐ 7.9 weeks, and the average body mass index was 26.7 +/‐ 4.2 kg/m2.ConclusionThese results reinforce the importance of following the ACC/AHA guidelines for blood pressure measurement in clinical practice. Clinic measurements may be falsely elevated in pregnancy.